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Fact check: What are the average costs of emergency care for undocumented immigrants in US hospitals?
Executive Summary
The available literature does not provide a single, authoritative figure for the average cost of emergency care for undocumented immigrants in U.S. hospitals; recent studies and reports instead emphasize variation by state policy, payer mix, and visit type, and note substantial coverage gaps that complicate cost estimates [1] [2] [3]. Researchers and policy reports point to higher reliance on emergency departments for treatable conditions and to the financial stress on hospitals, but none of the provided sources give a clear mean or median cost per ED visit for undocumented patients [3] [4] [5].
1. Why a single “average cost” is missing and why it matters for policy debates
No study in the supplied set reports a definitive average dollar figure for emergency care costs specific to undocumented immigrants; instead, researchers document heterogeneity in utilization and funding mechanisms that prevent clean aggregation [3] [1]. Variation arises because eligibility for emergency Medicaid and state-level expansions differs, because hospitals face different payer mixes and uncompensated care burdens, and because visits range from primary-care-treatable complaints to true emergencies—each with widely different costs. Reporting costs without accounting for these structural differences would mislead policymakers about the fiscal impact and potential savings of alternative interventions [1] [4].
2. What utilization studies show about the nature of visits and implied cost drivers
Recent clinic-based and ED-focused studies emphasize that a significant share of visits by undocumented patients are for acute but potentially primary-care-treatable conditions, which generally cost less than complex emergency procedures but drive volume and downstream spending [3] [6]. The clinic study points to preventable or primary-care-appropriate ED use, implying cost-reduction opportunities through better access to outpatient care; the ED literature highlights unique clinical and social determinants that can lengthen visits and increase resource needs, such as late presentation and coexisting social needs [3] [6]. Those patterns shape but do not quantify average costs.
3. How state policy and emergency Medicaid shape who pays
State-level policy choices—coverage of emergency Medicaid, options to cover certain chronic conditions, and variations in administrative rules—produce substantial differences in whether federal funds cover emergency care for undocumented people and for what scope of services, thereby altering hospital financial burdens and the apparent “cost” borne by taxpayers versus hospitals [1] [2]. A July 2025 synthesis found policy-driven variation and coverage gaps that make cross-state cost averaging misleading. Hospitals in states with broader emergency Medicaid implementation may see different uncompensated care rates than those in more restrictive states [1].
4. Hospital finance reports and national cost pressures provide context, not direct estimates
National reports from hospital associations and health system analyses describe rising labor, drug, and supply costs and mounting uncompensated care, which increase the per-encounter cost baseline for emergency services, but these documents do not disaggregate costs by immigration status [4] [5]. The AHA reports [7] show systemic cost pressures that would affect any ED patient’s cost of care; therefore, claims that undocumented patients impose uniquely high per-visit costs require direct, disaggregated data that the provided materials do not include [4] [5].
5. Financial burden literature and per-capita expenditure estimates offer partial views
Analyses of healthcare debt and per-capita expenditures highlight that undocumented immigrants are more likely to be uninsured and subject to coverage gaps, with one earlier study citing an annual per-person expenditure for unauthorized immigrants ($1,629 in a 2020 study mentioned in the supplied material), but that figure is not specific to emergency department encounters and does not reflect inflation or state variation [8] [9]. Debt and uninsured-care studies underscore hospital revenue losses and patient financial strain, yet they do not convert those phenomena into a reliable average ED cost for undocumented patients in 2025 conditions [8] [9].
6. Bottom line: what evidence supports and what remains unknown for decisionmakers
The sources collectively support three firm findings: undocumented patients rely disproportionately on EDs for a mix of primary-care-treatable and acute needs; state emergency Medicaid rules materially change who pays; and rising systemic costs affect per-visit expenditures across the board [3] [6] [1] [4]. The central unknown is a rigorously computed, up-to-date average ED cost per undocumented patient that controls for visit acuity, state policy, hospital type, and inflation. Policymakers seeking such a number must commission claims-level analyses that link immigration status, encounter-level billing, and payer reimbursement across multiple states to produce defensible averages [1] [4].